The College of Registered Nurses of B.C. says a precedent-setting penalty to a nurse who financially exploited an elderly couple should serve as a deterrent to others thinking about enriching themselves at the expense of patients in their care.
Former nurse Laurie Tinkham, of Nanaimo, is the first B.C. nurse ever to be fined by the college for professional misconduct. In its decision, the college said Tinkham can’t apply to have her licence reinstated for at least five years.
Her fine totalled $17,500 — half the maximum fine under bylaws — after a three-year investigation and hearing process concluded she breached numerous ethical and professional standards while caring for a now-deceased elderly couple.
She was also ordered to pay investigation costs to the college of $16,536.
The nurse’s misdeeds include being the couple’s power of attorney and putting her name on the title of a $30,000 mobile home (which she still owns, according to B.C. Assessment Authority records) that was bought by the couple.
As well, the couple paid for her dentistry, vision care and $1,600 a month in medications. This was on top of a monthly stipend for her services that was kept to a certain threshold ($800) a month so that it would not jeopardize her taxpayer-funded long-term disability payments of $900 a month.
According to the college: “Her failing to maintain appropriate boundaries involved her reaping substantial financial benefits from an infirm client, and her also gaining access to assets through a power of attorney. Such conduct stands to significantly erode the public’s confidence in nurses, whom the public trusts to care for vulnerable clients.
“Ms. Tinkham’s conduct engages a need for measures that will deter similar conduct by other registrants, and promote public confidence in the profession and its ability to self-regulate.”
Cynthia Johansen, CEO of the College of Registered Nurses of B.C., said complaints about nursing interactions with the elderly have increased in recent years, but she couldn’t provide numbers or information about specific complaints. The college is exploring how to dig deeper into the trends and, in the meantime, is posting more case studies on its website to make sure nurses are aware of their ethical and professional responsibilities and boundary violations.
The college’s decision comes at a time when numerous agencies are reporting increases in cases of financial abuse of elders.
The Seniors Abuse and Information Line, operated by a non-profit organization called Seniors First B.C., reports that in 2014, 25.6 per cent of calls pertained to financial abuse. In 2015, the proportion rose to 28.9 per cent. In 2016, the last year for which such information is available, the proportion rose to 30.4 per cent.
The Vancouver Police Department tracks reports of physical and financial abuse of elders. Cases of financial abuse have risen from 119 in 2009 to 202 in 2016.
In most of the police cases, however, the suspect was neither a family member nor caregiver.
Complaints related to seniors are also fielded by a 211 Helpline, primarily funded by the United Way. Elder abuse (not just financial) accounts for 37 per cent of all calls.
A survey commissioned by Vancity Credit Union indicates that about 40 per cent of seniors in Vancouver and Victoria say they have been victims of financial abuse.
Isobel Mackenzie, seniors advocate of B.C., said she is “more familiar than I want to be” with the issue of financial exploitation of elders.
“Overwhelmingly, most relationships [between health professionals and older clients or patients] are fine. But from my own experience, I have seen everything, from care aides taking a few dollars out of a client’s wallet to those who’ve gone to the bank with clients to withdraw bigger amounts,” Mackenzie said.
“I can’t deny it happens. I’ve been in meetings with investigators hearing about these things. But when one thinks about the number of clients and visits, it’s thankfully still a small percentage.”
Mackenzie said the Tinkham case naturally will give rise to worries on the part of families hiring home-care workers.
“One challenge is context and perspective. We don’t want to create unnecessary fear and suspicion while drawing attention to this to create more awareness. We don’t want seniors to think everyone is going to rob them,” she said.
While the college website can be checked to find out about the licences of registered nurses, the database for the B.C. Care Aide and Community Health Worker Registry can also be consulted to learn whether workers have credentials. It also contains information on whether workers have been suspended or removed after being terminated for client abuse, including neglect and/or financial, emotional, physical or sexual abuse.
Mackenzie said she worries that with population aging and health-care worker staff shortages, people might be “tempted to lower the bar” when it comes to who they hire or not being sufficiently circumspect about home-care providers.
“Some are reticent to report anything, others don’t want to make waves,” Mackenzie said. “People want to give others the benefit of the doubt.”
In the Tinkham case, the former nurse admitted that the elderly man had a case of “romantic transference” that could have marred his judgment.
The Vancouver Island Health Authority was involved in the care of the couple, and an outreach worker was the first to spot and report the unusual arrangement between Tinkham and the couple.
Mackenzie said individuals can use the patient-care-quality offices of each B.C. health authority to file complaints about abuse or neglect.
More frail and vulnerable people are living longer in their homes, and Mackenzie suspects that that might be fuelling the increase in reports of elder abuse.
“The potential for financial abuse is significantly greater in home care. That is one of the biggest fears of seniors and their families,” she said.